Pregnancy and Thrombosis
Pregnancy creates an eight times higher risk for the development of thrombosis as compared to non-pregnant women. In addition, eighty times the risk of thrombosis approximately 6 weeks thereafter to the time of delivery. Annually, 2,000 women are diagnosed with thrombosis and/or pulmonary embolism during pregnancy in Germany. Symptoms of thrombosis are often misinterpreted or even absent leading to a high rate of undiagnosed and thus untreated thrombotic events. Untreated thrombosis is followed by venous insufficiency that will likely cause patients an ever-lasting impaired blood circulation, reduced function of the affected limb and recurrence of thrombosis.
Thrombosis and pulmonary embolism are potentially life-threatening diseases, which are the leading causes of maternal death rates in Western Europe and the USA for more than 30 years. According to a British survey in more than 60 % of deadly thrombosis inadequate risk assessment prior to the development of thrombosis resulted in omission of the required prophylactic treatment. Besides classical risk factors of thrombosis such as high body-weight, immobilisation, chronic diseases, previous thrombosis, smoking or genetic thrombosis favouring disorders such as Factor V Leiden- or Prothrombin- mutation, pregnancy itself goes along with significant increase in clotting activity and a two- to three- fold elevation of most clotting factors induced by the placenta. There is a strong association between the development of thrombotic complications during pregnancy and maternal age over 35 years as well as a positive family history of thrombosis. Normalization of clotting and thus risk reduction of thrombosis may take up to 6 to 12 weeks after delivery.
Individual risk evaluation for thrombosis should be considered before or at least early during pregnancy, if some of the aforementioned factors are present in order to initiate timely and adequate dosing of thrombosis prophylaxis. Women with a history or acute thrombosis may need to adapt the kind and dose of treatment during pregnancy and childbed.
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